When the caregiver helps the patient up from the floor, both must be kept safe. If this is not possible, additional help such as a medical alert system may be needed. If possible, the gait belt should be snug for better leverage. Transfers should be coordinated between the patient and caregiver to ensure simultaneous maximal effort and to minimize strain on both. The caregiver can accomplish this by giving instructions such as “On the count of three try rolling onto your hands and knees” or “On the count of three try to stand up.” Because of Parkinsonian symptoms, the patient may not initiate movement at the count of three. The caregiver should be advised of this possibility so that she or he can delay giving assistance until the patient starts. Coordination of effort will avoid placing excessive strain on the caregiver. Caregivers should be encouraged to use optimal lifting body mechanics. I have found the following methods to be effective ways of getting up from the floor. Some patients may have unique restrictions that do not allow them to be supported in these areas. In such cases modifications of hand placement or gait belt placement will be necessary.

Assisted side lying to hands-and-knees position. The optimal hand placement of the caregiver is to position one hand under the bottom hip and the other hand under the gait belt. The caregiver pulls up on the patient’s hips as if turning a big wheel (figure 11.6, a and b). The caregiver should flex the knees to facilitate lifting with the legs rather than the back.

Assisted prone to hands and knees. If the patient has strong arms, the caregiver (with proper body mechanics) can straddle the patient, grab the gait belt, and lean back while pulling up on the belt. At the same time the patient pushes with the arms (figure 11.7). As the patient walks her or his hands backward, the caregiver walks backward and guides the hips into the all-fours position.

Assisted half kneeling to standing. The caregiver stands on the side of the patient that requires greater support. This positioning allows the patient to assist with his or her strongest side, which reduces difficulties in general. The caregiver places one hand on the gait belt and the other arm under the patient’s axilla (figure 11.8).

What to Do After a Fall

Patients often want to get up from the floor immediately after a fall. This desire may be due to the embarrassment of falling or their concern about their ability to get up. Sometimes patients do not think about the fact that after they have fallen, they cannot fall any farther and should be in no hurry to get up. Bystanders occasionally offer a helping hand, but their help may cause greater destabilization or irritate an already arthritic joint. Educating the patient about how to guide bystanders will help minimize these problems. Here are some general guidelines about what to tell your patient:

1. Do not try to get up right away.

2. Before attempting to get up, mentally note whether any areas feel injured. If you suspect injury, seek medical attention.

3. Attempt to relax for a moment before getting up.

4. If you are in your “off” medication state and are not very mobile, wait until medications are working before getting up. If you are not alone, someone can make you comfortable in the meantime with a pillow or other soft item.

5. Before attempting to get up, someone should bring a chair close to you if needed so that you can use it for support to get up.

6. An additional chair could be placed behind you if you have difficulty turning. After you are standing, you can sit on the chair without having to turn.

Appendix D contains the handout “What to Do After a Fall” that you may photocopy for your patients. Items 1, 2, and 3 are applicable to all patients. Items 4, 5, and 6 are for patients with individual needs or greater mobility problems. When you give the list to a patient, cross out any items do not apply to that person.